In Memoriam: Robert A. Fishman, MD (1924-2012)FREE

Author Affiliations: Department of Neurology, University of California, San Francisco (Dr Hauser), and The Neurological Institute of New York, Columbia University Medical Center, New York, New York (Dr Rowland).

Robert A. Fishman, MD, former president of the American Neurological Association (1983-1984) and editor in chief of Annals of Neurology (1993-1997), died on December 4, 2012, from complications of Alzheimer disease. He was 88 years old. In many respects, his personal story parallels the evolution of the field of neurology, a specialty that was emerging throughout his long and highly productive career.

Born in 1924 in New York City, Bob Fishman's interest in science was awakened by a high school botany teacher who encouraged him to think about medicine. He graduated early, entered Columbia College at age 16, and continued an accelerated course all the way through medical school at the University of Pennsylvania, with World War II in full swing. He graduated from medical school in 1947, at the tender age of 22, and decided to pursue neurology, a specialty that he often said was “just beginning to creep into the medical schools” in the postwar years. Following an internship at Yale University and further clinical training at Massachusetts General Hospital, he entered the residency program at the Neurological Institute at Columbia Presbyterian Medical Center in New York, which had at the time the largest neurological service in the country. The physician draft for the Korean War interrupted his trajectory, however, and he found himself at the Walter Reed Army Institute of Research in Washington, DC. There, he trained in the use of isotopes and worked in the head injury program, later recalling that this was “a very good place to learn neuroscience.” After his tour of duty was over, Dr Fishman returned to Columbia to finish his residency as chief resident, and he joined the faculty a year later, in 1954.

In 1961, Fishman, along with Lewis P. “Bud” Rowland, accepted a full-time position with the Neurological Research Institute at Columbia, which had just constructed new laboratories; thus, they became co–principal investigators on one of the first Clinical Research Center National Institutes of Health grants awarded to multiple laboratories; Fishman and Leon Prockop led the cerebrospinal fluid laboratory, and Rowland the muscle laboratory. The two became known as “Bud and Bob, the Gold Dust Twins,” a moniker coined by Houston Merritt. Fishman was happy to be investigating scientific questions of clinical relevance, but in 1965, he was contacted by Lloyd Hollington Smith, who had served with him at Walter Reed. Smith was on a search committee at the University of California, San Francisco (UCSF), and they were looking for someone to “lead and spark” a modern department of neurology.

Bob Fishman had never been west of the Rockies, but Smith told him that the old UCSF was in the early stages of a renaissance, with new resources, new research towers, and new faculty positions. He convinced the Fishmans to come for a 4-day visit. There was a second visit, and a third. Finally, Fishman nudged the salary offer up to $30 000 with a promise of 7 full-time faculty positions for the Department of Neurology. He accepted the offer in 1966 and thrived as the chairman of the UCSF neurology department until 1992.

During his 26 years in that role, Dr Fishman built an extraordinary program that brought together many of the best clinicians, scientists, and educators in the field of neurology, and it has become a model for academic departments of neurology nationwide. Back in 1966, however, the UCSF neurology department was a lonely place, with empty laboratories and a residency program that could not find enough applicants to fill the openings. There was only one neurology researcher, with one small National Institutes of Health grant. It was difficult to attract patients to UCSF's main hospital, and there was no neurology service at San Francisco General Hospital or at the Veterans Affairs Medical Center.

Under Fishman's leadership, the Department of Neurology at UCSF underwent dramatic changes, and he proved to be a superb recruiter of top-notch neurologists. The department soon became rich with the talents of many international figures in neurology and neuroscience, whose names are too numerous to mention here. He understood that few of us are truly “triple threats”—a perfect combination of clinician, scientist, and educator—so, instead, he offered new recruits the flexibility to chart their own course, with teaching, bench science, clinical science, and clinical care combined in whatever proportions they preferred. He knew that they would perform well in the tasks they enjoyed the most, and it worked. He also began to attract outstanding trainees, inspiring and molding many of today's senior leaders who, in laboratories and classrooms across the United States, extend his legacy to yet another generation.

Throughout this period, Fishman continued to walk the walk as a productive investigator; his work was continuously funded by the National Institutes of Health for more than 3 decades. Building on his interest in the biology of brain edema, in a long-standing collaboration with Pak Chan, he elucidated the role of free radicals and excitotoxicity in tissue damage from a variety of insults, and he showed that administering superoxide dismutase could limit the size of an experimental stroke. He also authored the classic textbook Cerebrospinal Fluid in Diseases of the Nervous System (Saunders, 1992). His many honors and awards include the George W. Jacoby Award from the American Neurological Association in recognition for his outstanding contributions to neurology (1986) and the Distinguished Graduate Award from the University of Pennsylvania (1996) in recognition of his successful career-long efforts to enhance the study and practice of neurology while serving as a dedicated educator and mentor to his students and residents. His record of service includes serving as president of the American Academy of Neurology and of the American Board of Psychiatry and Neurology. He was a senior member of the Institute of Medicine of the National Academy of Sciences.

Bob Fishman will be remembered for the remarkable breath and depth of his knowledge of medicine, his unfailing good humor, and his wit and kindness. His aphorisms (“Fishmanisms”), served up with a wry smile and a twinkle in his eye, remain staples at UCSF and will continue to keep his spirit alive long after he has left the scene. Here is a sampling:

The smartest neurologist is the last neurologist to see the patient. The sensory exam almost kept me out of neurology. Sit on your hands when you present a patient. Floppy tone is normal. Never reject a job you haven't been offered. The patient has measles and a broken leg. A 2-year-old is a psychotic dwarf with a good prognosis.

Bob Fishman was a brilliant clinical neurologist, a legendary teacher, an accomplished translational neuroscientist, and a dear friend. He will be deeply missed, and we are unlikely to see his like again.

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